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+A 47-year-old woman presented to the hospital with a 1-month history of abdominal distention.
+Physical examination revealed a huge mass in the lower abdomen.
+The peripheral blood test showed elevated levels of carcinoembryonic antigen (CEA, 335.2 ng/mL [normal, <5 ng/mL]) and carbohydrate antigen (CA) 125 (219 U/mL [normal, <45 U/mL]) but a normal level of CA19-9 (9 U/mL [normal, <37 U/mL]).
+Computed tomography (CT) demonstrated a large, round mass with a maximum diameter of 15 cm in the pelvic cavity without the presence of ascites or pleural effusion (Fig.1a, ​b).
+Colonoscopy identified an elevated lesion with severe stenosis in the sigmoid colon, and histopathological examination of biopsy specimens from the tumor showed moderately differentiated adenocarcinoma.
+Although we scheduled an early operation, the patient developed acute dyspnea and general edema 2 weeks after the first CT scan.
+The second CT scan examination demonstrated massive bilateral pleural effusion with atelectasis and ascites (Fig.2a, b).
+Thoracic drainage and laparotomy were emergently performed.
+Macroscopically, the tumor in the sigmoid colon had invaded the serosa, and the huge pelvic mass was found to contain a right ovarian tumor.
+Several small nodules of peritoneal dissemination were distributed over the greater omentum.
+Perioperatively, 3800 mL of serous ascitic fluid was drained.
+Cytodiagnosis of the fluid drained from the ascites and pleural effusion revealed no tumor cells.
+Bilateral oophorectomy, total hysterectomy, omentectomy, and sigmoidectomy with regional node dissection were performed (Fig.3a).
+Histopathological examination of the resected specimens showed moderately differentiated adenocarcinoma in the tumors of both the ovaries and the sigmoid colon (Fig.3b).
+The dissected paracolic nodes showed malignant cells.
+Immunohistochemically, tumor cells from the ovaries and the colon both showed positive expression of cytokeratin 20 (CK20) but no expression of cytokeratin 7 (CK7), confirming that the ovarian tumors were metastases from primary colon cancer (Fig.4a, ​b).
+The postoperative course was uneventful, and both pleural effusion and ascites rapidly resolved.
+Postoperatively, a regimen of 5-fluorouracil (5-FU), leucovorin, and oxaliplatin (FOLFOX) was administered every 2 weeks for 5 months.
+At 29 months after the first operation, the patient required curative hepatic resection for liver metastases.
+At 78 months after the first operation, the patient remains alive with no evidence of a disease.